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American Journal of Disaster Medicine
Winter 2017, Volume 12
, Number 1

Evaluation of the association between disaster training and confidence in disaster response among graduate medical trainees: A cross-sectional study
Andrew Grock, MD; Adam R. Aluisio, MD, MSc; Elizabeth Abram, MD; Patricia Roblin, MS; Bonnie Arquilla, DO
Winter 2017; pages 5-9

Objective: Disasters by definition overwhelm the resources of a hospital and may require a response from a range of practitioners. Disaster training is part of emergency medicine (EM) resident curricula, but less emphasized in other training programs. This study aimed to compare disaster educational training and confidence levels among resident trainees from multiple specialties. Design: A structured questionnaire assessed graduate medical training in disaster education and self-perceived confidence in disaster situations. Cross-sectional sampling of resident trainees from the departments of surgery, pediatrics, internal medicine, and EM was performed. Setting: The study took place at a large urban academic medical center during March 2013. Participants: Among 331 available residents, a convenience sample of 157 (47.4 percent) was obtained. Main Outcome Measures: Outcomes investigated include resident confidence in various disaster scenarios, volume of disaster training currently received, and preferred education modality. Results: EM trainees reported 7.3 hours of disaster instruction compared to 1.3 hours in non-EM trainees (p < 0.001). EM residents reported significantly more confidence in disaster scenarios compared to non- EM residents except for overall low confidence levels for mega mass casualty incidents. The preferred education modality for both EM and non-EM residents was simulation exercises followed by lecture. Conclusions: This study demonstrated relatively lower confidence among non-EM residents in disaster response as well as lower number of disaster education time. These data report a learner preference for simulation training. Key word: disaster education DOI:10.5055/ajdm.2017.0253

Healthcare students interprofessional critical event/disaster response course
Tae Eung Kim, MD, FACEP; T Shankel; ET Reibling; J Paik; D Wright; M Buckman; K Wild; E Ngo; A Hayatshahi; LH Nguyen; TK Denmark; TL Thomas
Winter 2017; pages 11-26

Objective: Numerous disasters confirm the need for critical event training in healthcare professions. However, no single discipline works in isolation and interprofessional learning is recognized as a necessary component. An interprofessional faculty group designed a learning curriculum crossing professional schools. Design: Faculty members from four healthcare schools within the university (nursing, pharmacy, allied health, and medicine) developed an interdisciplinary course merging both published cross-cutting competencies for critical event response and interprofessional education competencies. Setting: Students completed a discipline-specific online didactic course. Interdisciplinary groups then participated in a 4-hour synchronous experience. This live course featured high-fidelity medical simulations focused on resuscitation, as well as hands-on modules on decontamination and a mass casualty triage incorporating moulaged standardized patients in an active shooter scenario. Participants: Participants were senior students from allied health, medicine, nursing, and pharmacy. Main Outcome Measures: Precourse and postcourse assessments were conducted online to assess course impact on learning performance, leadership and team development, and course satisfaction. Results: Students participated were 402. Precourse and postcourse evaluations showed improvement in team participation values, critical event knowledge, and 94 percent of participants reported learning useful skills. Qualitative responses evidenced positive response; most frequent recurring comments concerned value of interprofessional experiences in team communication and desire to incorporate this kind of education earlier in their curriculum. Students demonstrated improvement in both knowledge and attitudes in a critical event response course that includes interprofessional instruction and collaboration. Further study is required to demonstrate sustained improvement as well as benefit to clinical outcomes. Key words: interprofessional, bioterrorism education, critical event education, simulated clinical training, disaster education, team communication DOI:10.5055/ajdm.2017.0254

Comparison of START and SALT triage methodologies to reference standard definitions and to a field mass casualty simulation
Salvatore Silvestri, MD; Adam Field, MD; Neal Mangalat, MD; Tory Weatherford, MD; Christopher Hunter, MD, PhD; Zoe McGowan, MD; Zachary Stamile, MD; Trevor Mattox, BS; Tanner Barfield, BS; Aarian Afshari, MD; George Ralls, MD; Linda Papa, MD
Winter 2017; pages 27-33

Objectives: We compared Sort, Assess, Lifesaving Intervention, Treatment/Transport (SALT) and Simple Triage and Rapid Treatment (START) triage methodologies to a published reference standard, and evaluated the accuracy of the START method applied by emergency medical services (EMS) personnel in a field simulation. Design: Simulated mass casualty incident (MCI). Paramedics trained in START triage assigned each victim to green (minimal), yellow (delayed), red (immediate), or black (dead) categories. These victim classifications were recorded by investigators and compared to reference standard definitions of each triage category. The victim scenarios were also compared to the a priori classifications as developed by the investigators. Setting: MCI field simulation. Main outcome measure: Comparison of the correlation of START and SALT triage methodologies to reference standard definitions. Another outcome measure was the accuracy of the application of START triage by EMS personnel in the field exercise. Results: The strongest correlation to the reference standard was SALT with an r = 0.860 (p < 0.001) and ? = 0.632 (p < 0.001). START and SALT triage systems agreed 100 percent on both black and green classifications. There were significant correlations between the field triage and both START and SALT methods (p < 0.001, respectfully). SALT had a significantly lower undertriage rate (9 percent [95%CI 2-15]) than both START (20 percent [95%CI 11-28]) and field triage (37 percent [95%CI 24-52]). There were no significant differences in overtriage rates. Conclusions: In our study, the SALT triage system was overall more accurate triage method than START at classifying patients, specifically in the delayed and immediate categories. In our field exercise, paramedic use of the START methodology yielded a higher rate of undertriage compared to the SALT classification. Key words: MCI, START, SALT, gold standard DOI:10.5055/ajdm.2017.0255

Liberia national disaster preparedness coordination exercise: Implementing lessons learned from the West African disaster preparedness initiative
Melinda J. Morton Hamer, MD, MPH; Paul L. Reed, MD; Jane D. Greulich, MPH; Charles W. Beadling, MD
Winter 2017; pages 35-41

Objective: In light of the recent Ebola outbreak, there is a critical need for effective disaster management systems in Liberia and other West African nations. To this end, the West Africa Disaster Preparedness Initiative held a disaster management exercise in conjunction with the Liberian national government on November 24-25, 2015. Design: During this tabletop exercise (TTX), interactions within and between the 15 counties and the Liberian national government were conducted and observed to refine and validate the county and national standard operating procedures (SOPs). Setting: The exercise took place in three regional locations throughout Liberia: Monrovia, Buchanan, and Bong. The TTX format allowed counties to collaborate utilizing open-source software platforms including Ushahidi, Sahana, QGIS, and KoBoCollect. Participants: Four hundred sixty-seven individuals (representing all 15 counties of Liberia) identified as key actors involved with emergency operations and disaster preparedness participated in the exercise. Main Outcome Measures: A qualitative survey with open-ended questions was administered to exercise participants to determine needed improvements in the disaster management system in Liberia. Results: Key findings from the exercise and survey include the need for emergency management infrastructure to extend to the community level, establishment of a national disaster management agency and emergency operations center, customized local SOPs, ongoing surveillance, a disaster exercise program, and the need for effective data sharing and hazard maps. Conclusions: These regional exercises initiated the process of validating and refining Liberia's national and county-level SOPs. Liberia's participation in this exercise has provided a foundation for advancing its preparedness, response, and recovery capacities and could provide a template for other countries to use. Key words: civil military, humanitarian aid, disaster preparedness, Ebola response DOI:10.5055/ajdm.2017.0256

Risk perception and perceived self-efficacy of deaf and hard-of-hearing seniors and young adults in emergencies
Alina Engelman, DrPH, MPH; Susan L. Ivey, MD, MHSA; Winston Tseng, PhD; Linda Neuhauser, DrPH, MPH
Winter 2017; pages 43-50

Objectives: The authors explored the factors influencing risk perception and perceived self-efficacy before and during an emergency for deaf and hard-of-hearing (Deaf/HH) seniors and young adults. Methods: The authors collected demographic survey data and conducted four focus groups with 38 Deaf/HH residents of the San Francisco Bay Area; two groups were with young adults (ages 18-35), including one group of college students and one group of young professionals, and two were with older adults (ages 50-90). Results: Significant differences were found between Deaf/HH young adults and seniors in both the sources of self-efficacy and risk perception and their attitudes toward preparedness. All groups demonstrated high resilience. Deaf/HH young professionals expressed more concern about their risk in an emergency than Deaf/HH college students. Alternately, the risk perception of Deaf/HH older adults was often rooted in their past experiences (survival of past emergencies, inaccessibility of communications during drills). Conclusions: Policy implications include the need to dedicate more resources to increasing accessibility and relevance of emergency communications technology for Deaf/HH populations. This could help increase adaptability before, during, and after emergencies among all groups of Deaf/HH people, particularly among young Deaf/HH professionals. Key words: deaf, hard-of-hearing, disability, disasters, accessibility, emergencies, communication, emergency preparedness, risk perception, self-efficacy, qualitative methods, elderly, seniors, young adults DOI:10.5055/ajdm.2017.0257

Family emergency plan and preparedness among medical practitioners in Zaria, Nigeria
Jerry Godfrey Makama, MBBS, FWACS, FACS; Istifanus Anekoson Joshua, MBBS, MPH; Elizabeth Jerry Makama, RN, RM, PGDDRMDS, MDRMDS
Winter 2017; pages 51-58

Background: There has been an increase in the incidence of disasters in many parts of the world. Similarly, Nigeria has witnessed a recent increase of man-made disaster events such as plane crash, fire incidents, flood, and building collapse, including bomb blast orchestrated by terrorists that often create emergency situations. Therefore, the aim of the study was to evaluate family emergency plan and preparedness among medical practitioners in Zaria. Methods: This was a cross-sectional descriptive study (May-July, 2013) of medical practitioners in Zaria, Nigeria. The structured questionnaire sought the socio-demographic features of the respondents, the availability of emergency gate(s) in the house, education of safety measures within and outside the house, well-known located shut-off devices for gases, electricity, and water in the house, and written document/policy in the event of disaster. Also, planned orientations/ drills/sensitizations, whether there is contact information of family members and supporting agencies. Results: Majority of the respondents were male 56 (80.0 percent) and fall within the age group of 46-50 years (20.0 percent). Only 8.6 percent admitted having an unwritten policy on emergency management in their houses. Similarly, only 8.6 percent do create time to teach their family members on emergency management. Only 27 (38.6 percent) had emergency supplies kits and among this group, water appears to be the most essential component that the respondents had paid attention to, leaving out special items. The communication plans of respondents to likely supportive services/agencies during disaster showed that majority had contact address or have affirmative plans for hospital and ambulance services than for radio and television stations. Conclusion: Family emergency plans and preparedness among medical practitioners in Zaria are extremely low. There is a gap between knowledge of what need to be done to enhance preparedness and internalizing preparedness recommendations in the study area. Key words: family, household, emergency plan, disaster, preparedness, Nigeria DOI:10.5055/ajdm.2017.0258

Womenís status in disasters: A gap between expertsí desk and affected fields of Iran
Sanaz Sohrabizadeh, PhD
Winter 2017; pages 59-62

Although international agreements have achieved significant milestones in the improvement of womenís status, experiences from the fields show a discrepancy between words and actions. The aim of this brief communication was to identify the gap between expertsí perceptions and the findings of a large qualitative field survey on womenís status in the recent natural disasters of Iran. A total of 10 experts were asked to fill a checklist, which consisted of the concepts extracted from field data. The range of agreement between expertsí perceptions and field data was between 40 and 100 percent. In conclusion, although literature review and international research papers can provide appropriate information for both experts and managers, meeting the various needs of women living in the affected regions requires field-based surveys. Key words: women, experts, disaster, Iran DOI:10.5055/ajdm.2017.0259

Using a novel technology for disaster staff notification
Stephen C. Morris, MD, MPH; Janice K. Pelley; Steven H. Mitchell, MD, FACEP
Winter 2017; pages 63-65

Notification of backup staff and determining their ability to augment frontline staff is a major component of any disaster plan. However, the communication and organization of this effort has many challenges. These include communication system overload, the disaster setting, disrupted transportation, and staffing impacts on normal operations. An optimal disaster notification system must have the ability to be modified to include all hazards and the unique environment in which the plan is being made. This article highlights a unique disaster staff notification system using a novel technology, an outside administrator, and a multilayer system of redundant communication. Key words: disaster, staff notification, disaster administration, emergency department, emergency planning DOI:10.5055/ajdm.2017.0260